• <- Back to List

Acute Carpal Tunnel Syndrome After Open Distal Radius Fracture

Jaehon Kim, M.D.

Among the complications associated with distal radius fractures (DRFs), acute carpal tunnel syndrome (ACTS) can potentially lead to impairment of function and sensory deficits. The purpose of this investigation is to determine the incidence and identify the predictors of ACTS after open fractures of the distal radius.

This is a retrospective study of open DRFs which were prospectively enrolled into the common database of two level I trauma centers in City, State. All open DRFs treated between January 1, 2003 and December 31, 2010 were included in our review. The patient demographics, AO/OTA Comprehensive Classification, Gustilo and Anderson grade, and operative parameters were compared between open DRFs with and without ACTS using univariate analysis. The diagnosis of ACTS was identified based on clinical symptoms of persistent median nerve neuropathy that necessitated operative carpal tunnel release. The primary outcome was to determine the predictors of ACTS based on demographics, mechanisms of injury, fracture patterns, and type of fixation. Multivariate logistic regression was performed on significant variables from the preliminary univariate analysis to identify independent predictors of ACTS and determine the odds ratio (OR) as a measure of risk. The probability table of ACTS based on these predictors was also constructed.

One hundred thirty-nine open DRFs (107 grade I, 23 grade II, 9 grade III) met the inclusion criteria. Patient demographics, mechanism of injury, AO/OTA fracture type, and operative parameters between grade I and grade II were similar. Patients with grade III open DRF were more likely to be male and younger. The incidence of ACTS was 13.7% in all open DRFs (19 out of 139). Multivariable logistic regression analysis identified four predictors of ACTS: male sex (OR = 8.8, p = 0.001), Type III Gustilo and Anderson open injuries (OR = 6.2, p = 0.04), OTA fracture type C (OR = 3.8, p = 0.03), and the application of external fixation (OR = 14.0, p = 0.01). The probability of ACTS, determined by preoperative variables (i.e. excluding external fixation), was 80% with all three factors present and 2% with no risk factors.

Male sex, Gustilo and Anderson grade III, OTA fracture type C and external fixation were identified as significant predictors of ACTS after open DRFs. With clinical stratification of these characteristics, certain patients may be identified who may benefit from closer peri-operative surveillance, and possibly prophylactic carpal tunnel release.